Comparing intensive and less-intensive treatment for older patients with acute myeloid leukemia

This study aimed to compare the safety and effectiveness of intensive and less-intensive therapy for older adults with acute myeloid leukemia (AML). 

This study concluded that intensive therapy may lead to better outcomes for these patients when compared to less-intensive therapy. 

Older patients with AML usually have a higher risk disease. Standard chemotherapy regimens have proven to induce remission in up to half of these patients. However, older patients commonly have other medical conditions associated and a higher risk of developing side effects to intensive standard therapies. They are also usually excluded from clinical trials.

Less intensive treatment can be less effective in guaranteeing long-term remission but can be easier on the body. It can be a better option for patients who are older or have other medical problems.  

It was unknown how the safety and effectiveness of intensive and less-intensive treatment compared for older adults with AML. 

This study analyzed data from 25 studies including 7825 patients with AML. Patients were treated with either intensive or less intensive regimens. The most common intensive treatments included cytarabine (Cytosar-U)-based chemotherapy, a combination of cytarabine and anthracyclines, or daunorubicin (Cerubidine)/idarubicin (Idamycin), and cytarabine plus idarubicin.  

The most common less-intensive therapies included low-dose cytarabine alone or combined with clofarabine (Clolar), azacitidine (Vidaza), and hypomethylating agent (HMA)-based chemotherapy.  

Patients who received intensive treatment were 13% more likely to experience longer survival compared to those who received less-intensive treatment. Also, patients who received intensive treatment were 6 times more likely to receive a stem cell transplant and 75% less likely to experience pneumonia compared to patients who received less-intensive treatment.   

Overall, patients treated with intensive treatment were 34% more likely to experience severe side effects compared to those receiving less-intensive treatment. More intensive treatment was also associated with a longer duration of intensive care unit hospitalization compared to patients who received less-intensive treatment.

This study concluded that intensive therapy for older adults with AML may lead to better outcomes when compared to less-intensive treatment.  

Most of the studies analyzed were done on medical records data. More randomized trials are needed.